An unsanitary tale of urban Pakistan

Health, Water

Floods and drought in rural areas are leading to mass migration into urban centres, however, weak governance and disempowered communities are leading to ever-worsening issues of sanitation and hygiene. Here, Alan Brouder looks at the living conditions in Dadu, Pakistan and steps being taken to improve upon it, including formation of active citizenship groups for community development.

In the city of Dadu, in Pakistan’s southern Sindh province, 15-day-old twins Zameer and Zameera Solangi are struggling to survive as their bed-ridden mother Rashida becomes increasingly weak. Failing to produce enough breast milk for both babies, Rashida must choose between them. For most of the past two weeks, she has chosen to feed Zameer, the boy. However, as his sister becomes weaker with malnutrition, Zameer is now suffering from diarrhoea.

One woman told us that 5 of her children had died from diseases related to dirty water or poor sanitation and hygiene 

The complete absence of clean water and sanitation in the Pir Buksh neighbourhood of Dadu means that illness and death are commonplace. Few homes have pit latrines, and those that do are shared between 20 to 25 people in each household. Women and girls must wait until all the men have left before using the latrine as there is no privacy in these cramped conditions. Overflowing sewers line the streets, where children defecate openly and where all solid waste is dumped. Most of the hand pumps are not working, and the few water pipes laid in the 1970s by the district authorities are
either broken or are delivering water mixed with effluent and high levels of arsenic. People are too poor to buy bottled water (and so none is available), so they all continue to drink the dirty water and cook with it. 

All of the open sewers empty into a torrid, 8-metre-deep ‘pond,’ adjacent to the school, where at least two children have drowned in the past year. Skin disease is rife, along with gastroenteritis, dysentery, hepatitis, TB, malaria, and dengue fever. A case of polio was confirmed last month, following two cases last year. Pakistan is one of only three countries in the world (along with Afghanistan and Nigeria) that have failed to eradicate polio, and 85% of all cases are in Pakistan. One woman told us that five of her children had died from diseases related to dirty water or
poor sanitation and hygiene.

Pakistan is 1 of 3 countries that have failed to eradicate polio and 85% of all cases are in Pakistan. The mother of the twins is also suffering from an unidentified water-borne illness in addition to complications as a result of the Caesarian section she underwent, but she is also most likely suffering from severe depression. While she was pregnant, Rashida’s husband Zahid was tortured by the police before being shot dead, according to her family. The police claimed that Zahid was guilty of theft and had resisted arrest, but the family and
others told us it was more likely that the police were hired as contract killers to resolve a minor dispute. In order to minimise the chances of retribution, the police then took Zahid’s only brother Majid and locked him up without charge. The family says they don’t expect to see him again.

With the loss of their father and uncle, the twins’ 75-year-old grandfather Mohamed Qasim Solangi has been forced to search for day labour to provide for the remaining seven members of the household (women are not discouraged from working outside the home, but there are no livelihood opportunities here apart from construction). On the days when Mohamed does find employment, he earns between 100 and 200 Rupees (USD1-2) for 8-10 hours of manual labour in a city where temperatures can reach 53 degrees in the summer, and where increasingly frequent and intense floods wreak havoc

Not only do the floods prevent people from working and earning an income (one person told us that “one day of rain means ten days without food”); they also raise the levels of the open sewers throughout the neighbourhood, creating a treacherous network of foul canals that must be navigated if people are to leave their flooded homes. Floods and drought in surrounding rural areas have also led to large-scale migration to the cities. Dadu’s population has risen from 75,000 in the 1980s to an estimated 500,000 today.

Effective Citizen Groups can draw up their own community development plans and discuss priorities with local authorities As is so often the case, weak governance and disempowered communities are major factors in the persistence of these problems. Oxfam’s Global Urban Framework (GUF) sets out a theory of change based on active citizenship and improved governance for addressing urban poverty. In line
with the GUF, the Pakistan team will soon carry out a detailed political economy analysis of the WASH sector, along with a more thorough analysis of governance structures in the country that have an impact on the provision of WASH services. The country team has already started to mobilise these communities into ‘Effective Citizen Groups’ in which they can draw up their own community development plans and discuss their priorities with local authorities.

Giving these people a voice for first time in decision-making processes that affect their lives is just the beginning of a long and complicated struggle to improve their lives, and so we are building relationships with local, provincial, and national authorities, as well as other key actors in the sector, such as UN-HABITAT and the World Bank. Oxfam has been invited to participate in a National Habitat Steering Committee in advance of the HABITAT III conference in 2016, a global platform for shaping the urban development agenda that takes place only every 20 years. This will be the
first time that we have developed an urban WASH governance programme from scratch. It should therefore be a rich source of learning for others aiming to do the same elsewhere. We will be posting the learning from the programme here over the next two years.

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Author: Alan Brouder
Archive blog. Originally posted on Oxfam Policy & Practice.